Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
Am J Surg. 2012 Jul;204(1):44-8. doi: 10.1016/j.amjsurg.2011.04.007. Epub 2011 Oct 13.
Frequency and characteristics of metachronous occurrence of multifocal intraductal papillary mucinous neoplasms (IPMNs) or distinct pancreatic ductal adenocarcinomas (PDACs) in the remnant pancreas during follow-up evaluation after pancreatectomy for IPMNs have not been well known. The aim of this study was to investigate the outcomes after resection of IPMNs, especially focusing on the metachronous occurrence of multifocal IPMNs and distinct PDACs.
Medical records of 172 patients who underwent resection of IPMNs were reviewed retrospectively, and the data regarding the occurrence of metachronous IPMNs or PDACs in the remnant pancreas during a mean postoperative follow-up period of 64 months were collected.
The incidence including synchronous and metachronous multifocal occurrence of IPMNs was 20% (34 of 172), and that of distinct PDACs was 9.9% (17 of 172). Ten metachronous IPMNs developed in the remnant pancreas after a mean time of 23 postoperative months (range, 12-84 mo), and 2 with main duct IPMNs (both were carcinoma in situ) required remnant pancreatectomy. Six distinct PDACs developed in the remnant pancreas after a mean time of 84 postoperative months (range, 12-150 mo). Four of them were found to have a tumor with a size of less than 2 cm, whereas the remaining 2 PDACs were found to be unresectable more than 10 years after resection of IPMNs.
Intense long-term follow-up evaluation is necessary for the early detection of metachronous occurrence of distinct PDACs as well as malignant IPMNs after resection of IPMNs.
在因胰腺内分泌肿瘤行胰切除术的患者中，在随访期间，残留胰腺内多灶性胰腺导管内乳头状黏液性肿瘤（IPMN）或胰腺导管腺癌（PDAC）的异时性发生的频率和特征尚不清楚。本研究的目的是探讨 IPMN 切除术后的结果，特别是聚焦于多灶性 IPMN 和胰腺导管腺癌的异时性发生。
回顾性分析 172 例行 IPMN 切除术患者的病历，收集平均术后随访 64 个月时残留胰腺内多灶性 IPMN 或 PDAC 发生的相关数据。
包括同步和异时性多灶性 IPMN 发生率为 20%（172 例中有 34 例），胰腺导管腺癌的发生率为 9.9%（172 例中有 17 例）。10 例异时性 IPMN 在术后平均 23 个月（12-84 个月）后在残留胰腺中发生，其中 2 例主胰管 IPMN（均为原位癌）需要行残胰切除术。6 例胰腺导管腺癌在术后平均 84 个月（12-150 个月）后在残留胰腺中发生。其中 4 例肿瘤直径小于 2cm，而另外 2 例 PDAC 在 IPMN 切除后 10 年以上发现无法切除。
在胰腺内分泌肿瘤切除术后，有必要进行长期的强化随访，以便早期发现异时性发生的胰腺导管腺癌以及恶性 IPMN。
